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Prescribed by the Iowa Secretary of State Revised 12/2020 State of Iowa Nomination Petition for Partisan Office Candidate Information Candidate’s Name: Office Sought: Candidate’s County of Residence: Office District (if any) Type and Date of Election: General on Special on Is the candidate running to fill a vacancy due to the death, resignation, removal, or temporary appointment of an office holder? No Yes Candidate’s Affiliation (Candidate, please check one box.) Not affiliated with any organization. OR Name of Non-Party Political Organization (No more than 5 words; exactly as it should appear on the ballot) Required For Federal and Statewide Petitions: Petition pages shall contain signatures from only one county. The name of the county must appear on each petition page. This petition page contains the signatures of eligible electors from We, the undersigned eligible electors of the appropriate county, supervisor or legislative district in the state of Iowa, hereby make the nomination outlined above. If the candidate named above accepts the nomination, we believe the candidate is or will be a resident of the appropriate county, supervisor or legislative district within the time frame required by law (60 days prior to the general election for state senate and state house candidates). Sign Your Name Iowa Residential Address (where you live) Today’s Date House Number and Street City 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.